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  5. PEDIATRICS IN BREVARD, P.A.

PEDIATRICS IN BREVARD, P.A.

Company Details

Entity Name: PEDIATRICS IN BREVARD, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 30 Oct 1997 (27 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 09 Mar 1998 (27 years ago)
Document Number: P98000017379
FEI/EIN Number 593477388
Address: 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
Mail Address: 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
ZIP code: 32955
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1154303790 2005-11-18 2020-08-22 134 S WOODS DR, ROCKLEDGE, FL, 329553262, US 134 S WOODS DR, ROCKLEDGE, FL, 329553262, US

Contacts
Phone +1 321-636-3066
Fax 3216362545

Authorized person
Name MRS. KAREN ALLISON
Role BUSINESS OFFICE MANAGER
Phone 3216363066

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2020 593477388 2021-08-24 PEDIATRICS IN BREVARD, P.A. 104
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363066
Plan sponsor’s address 134 S. WOODS DR., ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2021-08-24
Name of individual signing DR. PAUL TEBBE
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2019 593477388 2020-09-01 PEDIATRICS IN BREVARD, P.A. 98
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363081
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2020-09-01
Name of individual signing DR. MARY ULRICH
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2018 593477388 2019-07-31 PEDIATRICS IN BREVARD, P.A. 97
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363066
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2019-07-31
Name of individual signing DR. MARY ULRICH
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2017 593477388 2018-10-12 PEDIATRICS IN BREVARD, P.A. 100
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363081
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2018-10-12
Name of individual signing DR. ANIELA BOROWSKI
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2016 593477388 2017-10-04 PEDIATRICS IN BREVARD, P.A. 104
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363066
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2017-10-04
Name of individual signing DR. HIEP LE NGUYEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-04
Name of individual signing DR. HIEP LE NGUYEN
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2015 593477388 2016-10-14 PEDIATRICS IN BREVARD, P.A. 117
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363066
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2016-10-14
Name of individual signing HIEP LE NGUYEN, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-14
Name of individual signing HIEP LE NGUYEN, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2014 593477388 2015-09-28 PEDIATRICS IN BREVARD, P.A. 109
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363066
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2015-09-28
Name of individual signing HIEP LE NGUYEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-28
Name of individual signing HIEP LE NGUYEN
Valid signature Filed with authorized/valid electronic signature
PEDIATRICS IN BREVARD, P.A. 401(K) PROFIT SHARING PLAN 2013 593477388 2014-10-06 PEDIATRICS IN BREVARD, P.A. 108
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1982-10-01
Business code 621111
Sponsor’s telephone number 3216363066
Plan sponsor’s address 134 S. WOODS DRIVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2014-10-06
Name of individual signing JOHN KENNEDY, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-06
Name of individual signing JOHN KENNEDY, MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FORCIER TARA AM.D. Agent 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955

President

Name Role Address
FORCIER TARA AM.D. President 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955

Director

Name Role Address
FORCIER TARA AM.D. Director 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
NGUYEN HIEP LM.D. Director 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
ULRICH MARY WM.D. Director 2105 PALOMINO ROAD, MELBOURNE, FL, 32934
TEBBE PAUL CM.D. Director 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
KENNEDY JOHN CM.D. Director 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
Pena Monica AMD Director 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955

Secretary

Name Role Address
NGUYEN HIEP LM.D. Secretary 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955

Treasurer

Name Role Address
NGUYEN HIEP LM.D. Treasurer 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955

Vice President

Name Role Address
ULRICH MARY WM.D. Vice President 2105 PALOMINO ROAD, MELBOURNE, FL, 32934
TEBBE PAUL CM.D. Vice President 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
KENNEDY JOHN CM.D. Vice President 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955
Pena Monica AMD Vice President 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL, 32955

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G24000078490 PEDIATRICS IN BREVARD ACTIVE 2024-06-27 2029-12-31 No data 134 S WOODS DRIVE, ROCKLEDGE, FL, 32955

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2017-03-13 FORCIER, TARA A., M.D. No data
CHANGE OF PRINCIPAL ADDRESS 2012-03-08 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL 32955 No data
CHANGE OF MAILING ADDRESS 2012-03-08 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL 32955 No data
REGISTERED AGENT ADDRESS CHANGED 2012-03-08 134 SOUTH WOODS DRIVE, ROCKLEDGE, FL 32955 No data
NAME CHANGE AMENDMENT 1998-03-09 PEDIATRICS IN BREVARD, P.A. No data

Documents

Name Date
ANNUAL REPORT 2024-03-01
ANNUAL REPORT 2023-01-24
ANNUAL REPORT 2022-03-08
ANNUAL REPORT 2021-02-08
ANNUAL REPORT 2020-03-13
ANNUAL REPORT 2019-03-21
ANNUAL REPORT 2018-03-12
ANNUAL REPORT 2017-03-13
ANNUAL REPORT 2016-03-02
ANNUAL REPORT 2015-02-26

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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